| NPI | 1417082090 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA184721) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA184721) |
| 363A00000X Physician Assistant (Licence: NC 0010-04441) | |
| 363A00000X Physician Assistant (Licence: TN 2581) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2021-01-25 |